UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DAVIS FAMILY IRREVOCABLE TERM TRUST P O BOX 19366 JACKSONVILLE, FL 32245-9366 |
 |  X |  |  |
Scott A. Oko; Trustee for Davis Family Irrevocable Term Trust | 01/07/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | On December 29, 2004, in connection with the formation of the Davis Family Irrevocable Term Trust "DFI Trust" certain shareholders of Winn-Dixie Stores, Inc. "WD" (collectively, the "Grantors") contributed their shares of WD stock to DFI Trust in exchange for separate shares of beneficial interest in DFI Trust. As a result of such contributions of securities by the Grantors, the DFI Trust has a beneficial interest in more than 10% of WD's shares. Such shares are held directly by DFI Trust. |